Ventilation with the esophageal-tracheal Combitube during general anaesthesia: assessing complications in 540 patients

Abstract

Background: The esophageal-tracheal Combitube (ETC) was developed for the management of difficult airways but can also be used for general anaesthesia.
 Methods: This clinical study collected data from patients undergoing anaesthesia with the ETC in order to assess the rate of complications.
 Results: Five hundred forty patients were ventilated with the ETC. In 94.8% (512/540), insertion was performed for the first time by the respective physician. The following minor complications were observed: 38.7% sore throat, 30.9% blood on tube as sign of mucosal lesions and 17.0% cyanotic tongue. Experience decreased the risk of mucosal lesions (odds ratio [OR]: 2.3, 95% confidence interval [CI]: 1.5–3.5). A higher than recommended volume of the oropharyngeal cuff was associated with blood on the ETC (OR: 1.5, 95% CI: 1.0–2.3) and tongue cyanosis (OR: 2.3, 95% CI: 1.4–3.7). Ventilation for more than 2 h was associated with tongue cyanosis (OR: 2.2, 95% CI: 1.6–3.1) and tongue protrusion (OR: 1.4, 95% CI: 1.1–1.9).
 Conclusion: We conclude that the Combitube may be used for short procedures requiring general anaesthesia, but the high rate of minor complications limits its value when other alternatives such as a laryngeal mask airway are available. The tested method appears safe regarding major complications, but minor complications are common. Adherence to recommended cuff volumes, experience with the ETC and limiting its use to surgeries lasting less than 2 h might reduce the rate of complications.

Supraglottic airway devices: a powerful strategy in airway management

“…In more than 95% of cases, combitube can be effectively inserted into the esophagus with blind insertion, enabling a rapid insertion [50]. Blood gas measurements showed a significantly higher mean arterial oxygen tension during ventilation with the ETC [51,52]. The combitube represents a non-surgical airway alternative within the arsenal of anesthesiologists and emergency practitioners, particularly in the context of anticipated or unanticipated challenging airways in patients who are unable to be intubated or mask-ventilated [50,53].…”